Program Schedule

Preventing Central Line Associated Bloodstream Infections (CLABSIs) in an Outpatient Pediatric Hemodialysis (HD) Unit

Session: Poster Abstract Session: Pediatric Healthcare – associated Infection Epidemiology and Prevention
Friday, October 10, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC

Preventing Central Line Associated Bloodstream Infections (CLABSIs) in an Outpatient Pediatric Hemodialysis (HD) Unit

Kirtida Mistry, Charmelle Hughes, Tracie Harris, Xiaoyan Song

Children's National Medical Center, Washington, DC

Background: In 2008, 37,000 CLABSIs occurred in American HD patients. Pediatric patients are particularly vulnerable; but few evidence-based prevention strategies exist.  This study describes a stepwise approach to prevent CLABSIs in a pediatric HD patient cohort.

Methods: This study includes CLABSIs identified between 1/2011 and 12/2013 in HD patients treated at Children's National Health System. CLABSIs were defined using the Centers for Disease Control National Healthcare Safety Network definition.  Interventions, including blind audits of staff hand hygiene, were developed by systematically reviewing evidence-based practices and derived from root cause analyses (RCA).  Effectiveness of interventions was examined by plotting the CLABSI cases against the calendar month, and Poisson Regression to test changes of IR before (1/2011 – 6/2012, Phase 1) and after (7/2012 – 12/2013, Phase 2) the interventions.

Results: 12 patients developed 35 CLABSIs including 28 (5.7 per 1000 catheter days) in Phase 1 and 7 (0.9 per 1000 catheter days) in Phase 2 (IR Ratio [IRR]: 6.3, p<0.001). In Phase 1, 10 CLABSIs occurred in 3 patients < 4 years (yr); 10 in 7 patients aged 4 – 13.9 yrs, and 8 in 4 patients aged 14 – 19 yrs. The 7 CLABSIs in phase 2 occurred in 4 patients aged 4 – 13.9 yrs.  Leading pathogens in Phase 1 were Staphylococcus epidermidis (n=13, 33%) followed by Enterococcus faecalis (n=11, 28%); compared to Staphylococcus epidermidis (n=3, 23%) and Staphylococcus aureus (n=2, 17%) in Phase 2. Staff hand hygiene compliance rate increased from 38% in 8/2012 to 100% in 12/2013. The Figure depicts interventions instituted since July 2012.

Conclusion: Multifactorial interventions that include improving staff hand hygiene, adopting best practice for catheter care, collecting timely information through RCAs, and improving patient and caregiver knowledge about catheter care at home are effective in preventing CLABSIs in pediatric HD patients.

Kirtida Mistry, MBBCh, DCH, MRCPCH1, Charmelle Hughes, RN BS2, Tracie Harris, MT(ASCP), CIC2 and Xiaoyan Song, PhD, MBBS3, (1)Pediatric Nephrology, Children's National Medical Center, Washington, DC, (2)Children's National Medical Center, Washington, DC, (3)George Washington University School of Medicine, Washington, DC


K. Mistry, None

C. Hughes, None

T. Harris, None

X. Song, None

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